RT-PCR Positive Cases Research Articles

Socio-Demographic and Clinical Profile of COVID-19 in Children

Background: Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is a global pandemic. Infection by COVID-19 in children is not so common but gradually the numbers of children affected with COVID-19 are increasing day by day. Covid-19 has spread around Bangladesh and children are also being infected with comparatively fewer symptoms and lower case-fatality rates. To describe the epidemiological and clinical characteristics of hospitalized children with COVID-19. Materials and methods: This cross sectional observational study was conducted among 154 COVID-19 children who were admitted in COVID-19 dedicated Chattagram Maa Shishu O General Hospital, Chattagram from 15 April 2020 to 21 August 2022. Their signs, symptoms, sex, age distribution, laboratory results and familial contact were analyzed. Results: Among 154 children total RT-PCR positive cases were 82 (52%) and suspected cases were 72 (47%). Among positive casesmale-female ratio was 1.78:1. Most of the children (64%) were in school going age (6-18 years).70% children were from urban area and 30% from rural area. Most of the children (78%) came from middle and upper middle socioeconomic group and 22% from lower socioeconomic group. About 74% children were affected from family member.Main symptoms of the children were cough (72%), and fever (62%), fever with cough (56%) and diarrhoea (26%). About 58% of the children had additional symptoms including sore throat, nasal congestion, fatigue, headache, body ache, vomiting, abdominal pain, 32 patient came with shortness of breath. 7 patients had comorbidities. Among those 1 with CKD, 1 CP, 2 TB and 3 patients had asthma. Total 6 patients were died, 2 patients from positive cases and 4 patients from suspected cases. Among those 1 was CP child. About 14% patients showed lymphopenia, 14% showed leucopenia, 38% patient had neutropenia. C-Reactive Protein (CRP) and serum ferritin were high in only 52% and 38% cases respectively. There were 30% patients who had normal Chest X-Ray and 12% had bilateral consolidation and 58% had patchy opacities. Conclusion: The clinical manifestations in children are variable. However, fever and cough have mostly been profiled. Though the severe condition is rarely reported in children compared with adults, life-threatening complications, and death associated with COVID-19 disease have been documented. But it is evident that they may play a role in transmission of disease. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 14-17

Correlation of COVID-19 vaccination and RT-PCR ct value among cases in Addis Ababa, Ethiopia: implication for future preparedness

BackgroundThe COVID-19 disease requires accurate diagnosis to effectively manage infection rates and disease progression. The study aims to assess the relationship between vaccination status and RT-PCR cycle threshold (Ct) values by comparing clinical, RDT and RT-PCR results.MethodsA total of 453 suspected COVID-19 cases were included in this study. Nasopharyngeal swabs were collected for both RDT and RT-PCR testing, with RDTs conducted on-site and RT-PCR at the Ethiopian Public Health Institute (EPHI) genomics laboratory. Detailed clinical, RDT, and RT-PCR results were analyzed. Data analysis included descriptive statistics, cross-tabulation, and Chi-Square tests to investigate the connections between diagnostic outcomes and vaccination status, with a focusing on Ct values.ResultsRDT results showed 34.0% negative and 65.8% positive, while RT-PCR results indicated 35.8% negative and 64.2% positive cases. The discrepancies between RDT and RT-PCR results emphasize the importance of thorough testing. No significant association was found between vaccination status and viral load, as indicated by Ct values. Among RT-PCR positive cases, 49.8% had been vaccinated, suggesting challenges in interpreting results among vaccinated individuals. Further analysis revealed that vaccination (first or second dose) had minimal impact on Ct values, indicating limited influence of vaccination status on viral load dynamics in infected individuals.ConclusionsThe study highlights the significant differences between RDT and RT-PCR outcomes, underscoring the need for a comprehensive testing approach. Additionally, the findings suggest that vaccination status does not significantly impact RT-PCR Ct values, complicating the interpretation of diagnostic results in vaccinated individuals, especially in breakthrough infections and potential false positives.

Cytopathological study of pleural effusion in SARS-CoV2 RTPCR positive subjects during pandemic at tertiary care hospital

Introduction and Aim: Respiratory system is the most common system affected by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Review of literature reveals that pleural effusion were seen in one third of cases with Middle East Respiratory Syndrome(MERS) but were rarely reported in SARS –CoV2.This study aims to study the cytomorphological changes in Pleural effusion seen in SARS CoV-2 positive cases, to correlate the cytological findings with radiological CT COVID-19 Reporting and Data System(CORADS)scorings and to categorize pleural effusion as isolated cause of SARS CoV-2 or aggravation of underlying other etiologies. Materials and Methods: Pleural fluid samples of SARS CoV-2 RT PCR positive cases, obtained from patients of all age groups were included in the study. The samples were predominantly from Covid19 wave 1 (March 2020- February 2021) and few from Covid wave 2(March 2021-April 2021). Biochemical analysis, hematological parameters, cytomorphology and associated comorbidity was recorded, and analysis done. Results: Male predominance was observed. Most common cytological and biochemical finding in pleural fluid analysis was Exudative pleural effusion. Predominant cytological features showed lymphocytic effusion. Radiology showed maximum left sided pleural effusion (42%). CORADS score was 6 in majority of cases and effusion as an isolated cause was seen in few cases. Conclusion: Pleural effusion is a rare finding in SARS COV-2 induced bronchopneumonia. Effusion is seen with a high CORADS score, and they carry a high risk of mortality. This study suggests having SARS CoV-2 infection as a differential diagnostic entity when we find the mentioned morphological and biochemical findings as discussed in the present study.

Effect of Covid-19 Vaccination on disease Severity among Covid-19 patients admitted in KMCTH

Background: The COVID-19 Pandemic has affected millions of people globally with significant morbidity and mortality. Though the overall case fatality rate (CFR) in Nepal was less than 1% during the initial peak, the CFR is expected to increase during the current second wave of the pandemic. Since no specific effective therapies exist, breaking the chain of transmission sounds logical. COVID-19 vaccine development is believed to be effective and safe in preventing disease adverse outcomes. Aim: Primary aim of the study was to know the COVID-19 vaccination status among the patients admitted with RT-PCR positive for COVID-19 and secondary aim of the study was to observe the difference between the outcome in terms of resources utilization LIKE NON-INVASIVE VENTILATION (NIV), Hi-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) in vaccinated and unvaccinated patients. Method: This was a hospital-based Prospective Observational Study. All patients admitted at KMCTH from June 01, 2021 –July 31st 2021 with COVID-19 RT-PCR Positive meeting inclusion criteria were enrolled. Ethical Clearance was taken from KMC-IRC. Result: During the study period, a total of 160 RT-PCR Positive Covid-19 cases were admitted at Kathmandu Medical College Teaching Hospital (KMCTH). Out of the total patients, 74 (46.25%) were not vaccinated for covid-19 whereas 86 (53.75%) patients were vaccinated either with Vero cell (39.53%) or Covishield (60.47%) Covid-19 vaccine. The study showed 2.32% of vaccinated patients required ventilatory support compared to 13.50 % of unvaccinated patients requiring ventilatory support having significant ( p value <0.05) impact on outcome. The relative risk for unvaccinated patients going to ventilator was 5.81 times higher than for vaccinated patients. Conclusion: The authors found out that more than half of the individual admitted were vaccinated (53.75 VS 46.25). Moreover, Vaccination (either with Covishield or Vero cell) appears to be effective in limiting requirement of more advance services like NIV, HFNC, and invasive mechanical ventilator. We recommend a larger, multicenter, randomized study in the future.

Prevalence of Covid-19 and Associated Co-Morbidities at a Tertiary Hospital in Eastern Nepal

Introduction: COVID-19 (coronavirus disease) manifests as asymptomatic, mild, or severe pneumonia-like symptoms. COVID-19 patients with diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), hypertension, malignancies, HIV, and other comorbidities could develop a life-threatening condition.
 Objectives: To identify the various comorbid illnesses in COVID-19-positive patients along with its baseline characteristics in a tertiary hospital in eastern Nepal.
 Methodology: A one-month observational study carried out in RT-PCR positive COVID-19 patients in Birat Medical College and Hospital (BMCTH) Molecular Laboratory from June to July 2021. All the data was entered in a pre-structured proforma. The data was then further entered and analyzed by using Microsoft Excel 2014.
 Result: There were 354 (22.77%) RT-PCR positive COVID-19 cases and 1200 (77.22%) RT-PCR negative COVID-19 cases. More than half of the COVID-19 positive patients were males 211(59.60%). The most common symptoms were fever (92.3%), cough (83.5%) and tiredness (81.23%). Psycho-social stress such as anxiety, depression and insomnia 123 (34.74%) were common comorbidities followed by diabetes 91(25.70%) and hypertension 72(20.33%).
 Conclusion: COVID-19 patients were mostly between the 20-30 years of age group. Fever, cough, and throat pain were the commonest presenting symptoms.

Vitamin D in COVID-19

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) with clinical outcome ranging from asymptomatic to severe disease, and even death to some. It posed a terrifying challenge to healthcare system worldwide. Several observational and clinical trials has reported that, Vitamin D deficiency has contributed to acute respiratory distress syndrome. Case fatality rate increases with age and comorbidities, both of which are associated with decreased Vitamin D level. Therefore, this study is done to study the prevalence of 25(OH)Vitamin D in RT-PCR positive COVID-19 cases and RT-PCR negative controls.This is a hospital based cross-sectional study conducted at Jawaharlal Nehru Institute of Medical Sciences, Manipur on 88 RT-PCR positive Covid-19 cases and 88 COVID-19 negative controls over a period of 2 years. Analysis of the sample was done by Liaison 25(OH) Vitamin D Total Chemiluminescence assay(CLIA).In this study, statistically significant (p-0.018) lower plasma 25(OH)Vitamin D level is seen in COVID-19 positive cases (median 28±20.47) when compared to Covid-19 negative controls(median 33.50±10.66). The number of 25(OH) Vitamin D deficient is higher in Covid-19 positive cases when compared to Covid-19 negative controls -46(52.3%) and 30(34%) respectively with a high statistically significant value (p-0.015).COVID-19 positive cases have higher tendency to have suboptimal plasma 25(OH) Vitamin D level which may contribute to the high hospitalization risk in COVID-19 infection. This finding is important as it can identify population at risk, and contribute to interventions in reducing the risk of hospitalization associated with COVID-19 infection.

Predictors of Duration and Demand of Oxygen Therapy in Hospitalized RT-PCR Positive COVID-19 Patients

Background: Among many unexplored and challenging areas of COVID-19, pathophysiology of hypoxia and its management requires special attention for the physicians. The current study aimed to find the predictors of duration and demand of oxygen therapy in RT-PCR positive, hospitalized, COVID-19 patients. Methods: It was a prospective, multicentered, observational study conducted at Chattagram International Medical College (Isolation Ward, CIMC), Chattogram Medical College (COVID Red Zone) and Parkview Hospital Limited (COVID-19 Ward) from January to June 2021 on hospitalised, RT-PCR positive cases of COVID-19 patients of 18 yrs or above who required supplemental oxygen therapy and gave informed consent to be included in the study. All the participants underwent chest HRCT on initial presentation. Results: In this study, 85 consecutive patients of confirmed COVID-19 were recruited under the study. Patients required oxygen for a median duration of 6 days and median value of the maximum oxygen requirement was 7 L/min with a range between 1-100 l/min. In patients with no co-morbidity, one co-morbidity and more than one comorbidity, the median duration of oxygen therapy were 4.5 (3.0-7.8) hours and 7.0 (5.0-14.3) hours respectively. Multiple regression was run to predict maximum oxygen duration and maximum oxygen required for the patients from gender, age, smoking pattern, number of comorbidity and HRCT score; only total number of comorbidity and HRCT severity score added statistically significantly to the prediction, p < 0.05. Conclusion: The results of the study might be helpful in triage of COVID-19 patients, planning as well as clinical decision making. Bangladesh Medical Res Counc Bull 2023; 49(1): 75-80

Re-Introduction of West Nile Virus Lineage 1 in Senegal from Europe and Subsequent Circulation in Human and Mosquito Populations between 2012 and 2021.

West Nile virus (WNV) is a virus of the Japanese encephalitis antigenic complex and belongs to the family Flaviviridae of the genus flavivirus. The virus can cause infection in humans which in most cases is asymptomatic, however symptomatic cases exist and the disease can be severe causing encephalitis and meningoencephalitis. The virus is maintained in an enzootic cycle involving mosquitoes and birds, humans and other mammals such as horses can be accidental hosts. A mosquito-based arbovirus surveillance system and the sentinel syndromic surveillance network (4S) have been in place since 1988 and 2015 respectively, to better understand the transmission dynamics of arboviruses including WNV in Senegal. Arthropod and human samples have been collected from the field and analysed at Institut Pasteur de Dakar using different methods including RT-PCR, ELISA, plaque reduction neutralization test and viral isolation. RT-PCR positive samples have been analysed by Next Generation Sequencing. From 2012 to 2021, 7912 samples have been analysed and WNV positive cases have been detected, 20 human cases (19 IgM and 1 RT-PCR positive cases) and 41 mosquito pools. Phylogenetic analyzes of the sequences of complete genomes obtained showed the circulation of lineage 1a, with all these recent strains from Senegal identical to each other and very close to strains isolated from horse in France in 2015, Italy and Spain. Our data showed lineage 1a endemicity in Senegal as previously described, with circulation of WNV in humans and mosquitoes. Phylogenetic analyzes carried out with the genome sequences obtained also revealed exchanges of WNV strains between Europe and Senegal which could be possible via migratory birds. The surveillance systems that have enabled the detection of WNV in humans and arthropods should be extended to animals in a one-health approach to better prepare for global health threats.

Clinical Characteristics and Early Outcomes of Children with COVID-19 Infection admitted to Children Hospital in Dhaka City

Background: The burden of COVID-19 infection in children is lesser than adult; however, there are only a few data describing COVID-19 in pediatrics. Objective: The purpose of the present study was to determine the clinical characteristics and early outcomes of children with COVID-19 infection admitted to children Hospital in Dhaka city. Methodology: This is a prospective observational study included children of RT-PCR positive COVID-19 cases admitted to Dr. MR Khan Shishu Hospital & ICH between June2020 to November 2020. A total 95 children were enrolled. Patients were categorized clinically and visited every day during their hospital stay. This study included mode of presentation, the pattern of comorbidities, presence of co-infection, clinical trajectory & early outcomes. Clinical outcomes included survival, duration of oxygenation, lengths of hospital stay. Data were analyzed after collection of demographic and clinical data of 95 enrolled children. Results: Among 95 children with COVID-19 admitted to Dr. M R Khan Shishu Hospital & ICH, 56 (58.95%) were male and 39(41.05%) were female. Maximum 35 (36.84%) of the patients were between 1-5 years age group. 65 (68.42%) presented with respiratory symptoms and 19 (20%) presented with gastrointestinal symptoms. Twenty-five patients (26.32%) had significant preexisting comorbidities. Most common symptoms were fever 73(76.84%), cough 65(68.42%), sore throat 24(25.26%), diarrhea 21(22.11%). Oxygenation was required for 5 patients (5.26%). 1 patient (0.95%) had died and 1required ventilatory support in ICU. The median (range) hospital lengths of stay was 7(3-14) days. Conclusion: Most of the children with COVID-19 presented with mild to moderate symptoms & gastrointestinal symptoms were not uncommon. Most of the patients had good prognosis and only few patients required respiratory support. Bangladesh Journal of Infectious Diseases, April 2022;9(Suppl_1): S9-S13

Pre-vaccination RT-PCR negative contacts in workplace settings show high, SARS COV-2 neutralizing antibody levels

BackgroundAsymptomatic SARS-CoV-2 infection occurring in RT-PCR negative individuals represent a poorly characterized cohort with important infection control connotations. While household and community-based studies have evaluated seroprevalence of antibody and transmission dynamics in this group, workplace-based data is currently unavailable.MethodsA cohort study was carried out in July 2021, during and immediately following the peak of the 3rd wave of COVID-19 in Sri Lanka, prior to mass vaccination. A total of 92 unvaccinated individuals between the ages of 17–65 years were purposively sampled from an office and two factory settings. The selected cohort that had been exposed to RT-PCR positive cases in the workplace was tested RT-PCR negative. Serological samples collected six weeks post exposure were tested for anti-SARS-CoV-2 neutralizing antibody.ResultsThe seroprevalence for SARS-CoV-2 specific neutralizing antibodies in the overall cohort was 63.04% (58/92). Seroprevalences in the office setting, factory setting 1 and factory setting 2 were 69.2% (9/13), 55.7% (34/61) and 83.33% (15/18), respectively. Primary risk factor associated with seropositivity was face to face contact with no mask for > 15 min (p < 0.024, Odds Ratio (OR); 5.58, 95%CI;1.292– 25.65). Individuals with workspace exposure had significantly higher levels of neutralizing antibodies than those who did not (percentage neutralization in assay 63.3% (SD:21)vs 45.7% (SD:20), p = 0.0042), as did individuals who engaged socially without protective measures (62.4 (SD:21.6)% vs 49.7 (SD:21)%, p = 0.026).ConclusionThere was a high seroprevalence for SARS-CoV-2 specific neutralizing antibodies among RT-PCR negative contacts in workplace settings in Sri Lanka. Higher levels of transmission of SARS-CoV-2 infection than estimated based on RT-PCR positive contact data indicate need for targeted infection control measures in these settings during future outbreaks.

Prevalence of SARS -CoV-2 IgG/IgM antibodies among patients in Zakho City, Kurdistan, Iraq.

In 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent of Coronavirus Disease 2019 (COVID-19), spread all over the world. This global pandemic spread rapidly to more than 195 countries and caused over 200 million infections with a mortality rate of 2%. This study aimed to detect seropositivity against the SARS-CoV-2 virus among outpatients, symptomatic and asymptomatic individuals. A total of 489 individuals of age 5-70 years (mean 38.0 ± 17 SD) were enrolled for a cross-sectional study. They were tested for presence of SARS-CoV-2 IgM/IgG antibodies in serum samples using Enzyme-linked Immunofluorescent Assay (ALFA). A higher seroprevalence was recorded for IgM among females (34.96%) than males (28.83%). In the case of IgG, and IgG + IgM, both males and females had similar values. A significant correlation was identified between seropositivity and age; higher seropositivity (IgG, IgM, and IgG + IgM) was recorded in age groups 51-60 and ≥ 61 years, relative to the younger age groups. No significant correlation was found between symptomatic and asymptomatic individuals. No significant correlation was detected between seropositivity and RT-PCR positive and negative cases. COVID-19 is spreading rapidly and there is a high percentage of asymptomatic carriers. The sensitivity of RT-PCR tests is not uniform and may not be able to detect all cases. On the other hand, serology can be used for large scale testing to detect the real extent to which the disease has spread.

Investigating COVID-19 transmission and mortality differences between indigenous and non-indigenous populations in Mexico

ObjectivesIndigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among indigenous and non-indigenous populations at national and sub-national levels in Mexico. MethodsWe obtained data from the Ministry of Health, Mexico, on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000 person-weeks, mortality rate ratio (RR) among indigenous vs. non-indigenous groups, and hazard ratio (HR) for COVID-19 deaths across four waves of the pandemic, from February 2020 to March 2022. We also assessed differences in the reproduction number (Rt). ResultsThe mortality rate among indigenous populations of Mexico was 68% higher than that of non-indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among indigenous groups (P < 0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the Rt among the two groups was comparable. ConclusionIndigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks), and COVID-19 vaccination interventions among indigenous and non-indigenous populations in Mexico.

Efficacy of Different Drugs Used in COVID Patients in Bangladesh

Background: COVID 19 era is continuing globally even one and half years of turning out and claiming lives and startled with newly emerged variants. Many studies regarding COVID 19 treatment were published but some options were beneficiary in early stage and later were contradictory to apply it, making clinicians to dim. So this study was carried out reveal potential efficacy of commonly prescribed regimen in COVID unit. Materials and methods: This observational study conducted in three dedicated COVID hospital in Chattogram, Bangladesh. Total 209 cases with RT-PCR positive and symptomatic cases with RT-PCR negative subjects were enrolled in this study. Results: Half of the patients 53% (n=111) who got antiviral remdisivir, 53.6% n=103 were improved, 46.7% n=7 was died and p value &lt; 0.01,comparing to 28.2% (n=59) got favipiravir in whom, 27.6% n=53 were improved, 40% n=6 was died. 16.3% (n=34) patient got Tocilizumab, in whom 73.52% n=25 were improved, 23.52% n=8 was died. 8.6% (n=18) got convalescent plasma in whom 6.3% n=12 was improved, 40% n=6 was died and p value was significant. Those who were given both Tocilizumab and Remdisivir, 76.9% n=20 were improved and 19.2% n=5 were died in comparison to patient treated with Remdisivir only 97.6% n=83 were improved and 2.3% n-2 were died. Conclusion: Even after 18 months of starting COVID, only established treatment options are oxygen and dexamethasone. As data about efficacy of antiviral and others are so changing according to COVID variants and different country. So emphasize should be about prevention and avoiding injudicious use of anti COVID medications. IAHS Medical Journal Vol 5(1), June 2022; 56-59

Spectrum of HRCT Chest Findings in RT-PCR Positive Asymptomatic COVID-19 Patients at a COVID Designated Hospital in Nepal

Introduction: COVID-19 pandemic is grappling the world with the surge of infection time and again. Clinicians are trying to justify the ethics of public health care. Asymptomatic COVID-19 cases are going undocumented and most of them practice self-isolation. Studies have revealed significant radiological changes among RT-PCR positive asymptomatic COVID-19 cases. The aim of this cross-sectional study was to characterized chest CT findings of asymptomatic RT-PCR-positive patients in one of the COVID-designated hospitals in Nepal. Methods: This was a cross-sectional observational study where RT-PCR positive COVID-19 asymptomatic-close-contacts were subjected to HRCT chest. The HRCT images were evaluated by two radiologists for (a) characterizing the parenchymal involvement and (b) distribution of the involvement. The CT severity score (0-25) was calculated following the semi- quantitative scoring system which depends on the visual assessment of five lung lobes. Results: Out of 43, 26 (60.5%) participants had positive Chest CT scan findings consistent with COVID pneumonia. Bilateral lesions were present in 65% and 77% had multifocal lesions. The ground-glass opacities (92%), mixed (ground-glass opacities and consolidation pattern) (30.7%), and consolidation only (34.6%) were common chest CT findings. The median CT score was 3.5 (IQR; 2-6). Conclusion: Most of the RT-PCR positive COVID-19 asymptomatic patients had CT scan changes in lungs but with lower median CT score value.

Clinico-epidemiological Characteristics of Acute Covid-19 Patients in a Tertiary Care Hospital of Dhaka, Bangladesh

Background: The COVID-19 pandemic is a catastrophe enormously affecting the whole world including Bangladesh. This disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began in Wuhan, China, in December 2019, and since then has been spreading globally. Objectives: To find out the sociodemographic, clinical characteristics and in-hospital outcome of patients of acute COVID-19 confirmed cases in a tertiary care hospital. Methodology: It was a hospital based observational study. Consecutive samples were taken from RT-PCR positive cases (ranging from mild to severe form) admitted in COVID-19 unit of Shaheed Suhrawardy Medical College Hospital, Dhaka during the period of July 1st to August 31st 2020. Socio-demographic and clinical data were collected by using a pretested structured questionnaire. The severity of the COVID- cases was assessed based on the WHO interim guideline. Analysis was done with SPSS (Statistical Package for Social Science) version-23. Results: Total 77 cases were found valid for study according to inclusion and exclusion criteria. Male patients were predominant which was 72.7%. Mean age was found 53.32±13.48 years. The mean age was significantly higher (58.82±11.74 years) in severe group. Fever, shortness of breath (SOB), cough and body ache were the most common presenting symptoms. Body ache was significantly higher in mild &amp; moderate group than severe group. SOB and sore throat were significantly higher in severe group (53.5% vs 79.4%) and (9.3% vs 26.5%) respectively. Diabetes 29(37.7%), hypertension 18(23.4%), CKD 16(20.8%) and hypothyroidism 16(20.8%) were most frequent co-morbidities among the patients. Diabetes, CKD, hypothyroidism and COPD were significantly higher in severe group than mild &amp; moderate group. The mean neutrophil lymphocyte ratio (NLR) was found 1.3±0.3 in mild &amp; moderate group and 2.3±1.0 in severe group. Mean C-reactive protein was found 6.2±2.3 mg/L in mild &amp; moderate group and 8.5±3.9 mg/L in severe group. The mean sodium was found 143.6±7.9 mEq/L in mild &amp; moderate group and 136.5±9.8 mEq/L in severe group. The mean potassium was found 4.7±0.7 mEq/ L in mild &amp; moderate group and 3.9±1.2 mEq/L in severe group. Where X-ray chest (CXR) could reveal abnormalities only in 8 cases (10.4%); HRCT-chest was able to find out abnormalities in 56 cases (72.7%). Abnormal HRCT chest was found in 56 patients among them 48(87.3%) showed normal finding on chest x-ray. The difference was statistically significant between two groups. In HRCT chest abnormalities ground glass opacities (GGOs) was the most frequent observation in 33(58.93%) patients. GGOs was found 12(50.0%) in mild &amp; moderate group and 21(65.63%) in severe group. Major complications were pneumonia 39(50.6%) and severe pneumonia 28(36.4%) respectively. Pneumonia was significant higher in mild &amp; moderate group than severe group (76.7% vs 17.6%). Severe pneumonia was observed 27(79.4%) in severe group. The above-mentioned parameters were statistically significant (p&lt;0.05) between two groups. 2 patients (2.6%) died among them both were in severe group and both were male. Conclusion: Male sex and middle-aged population are mostly affected by the SARS-CoV-2. SOB and sore throat were significantly higher in severe group. Where facilities available strongly suspected individuals may go for HRCTchest. High NLR and CRP as well as lower value of sodium and potassium are good predictors for the severe or critical form of disease spectrum. J Bangladesh Coll Phys Surg 2022; 40: 183-190

A Preliminary Survey on the Oral Manifestation of COVID-19 in the First and Second Waves in Bhubaneswar, City of Odisha, India

Background: In both waves of COVID-19 infections, loss of taste was noted in a disproportionately high number of individuals. However, there is a considerable risk of dental disease during and after COVID -19 infections.&#x0D; Aim: Our aim here is to study the oral manifestation of the COVID -19 infections and make a comparison of the severity of presentation in the second wave with the first wave among the general population in Bhubaneswar, city of Odisha, India.&#x0D; Methods: A detailed online questionnaire was developed focusing on the oral manifestation during both the waves using Google forms.&#x0D; Results: Out of a total of 380 RT PCR positive cases, 91/169 and 167/211 cases with oral manifestation were obtained in the first and second waves, respectively. We found 41 (24.26 %) in the first wave and 63 (29.85 %) in the second wave of patients with oral manifestations over the age of 50. Patients receiving oxygen or using a ventilator were found to be 15 (8.9 %) in the first wave and 59 (28%) in the second wave.&#x0D; Conclusion: This is the first study to evaluate the correlation of oral infection with COVID 19 in different waves. This difference could be correlated with the virulence of viruses with mutated strains.

Epidemiologic and clinical characteristics of COVID-19 patients admitted in a tertiary care hospital in Khulna city

Background &amp; objective: The outbreak of coronavirus disease 2019 (COVID-19) has become a large threat to global health due to its high contagious nature and varied mortality. The number of infected cases and deaths are rising exponentially all over the world, including Bangladesh. This study aims to investigate the epidemiological and clinical features of COVID-19 patients admitted in Gazi Medical College Hospital (GMCH), Khulna, Bangladesh. Methods: In this study, we included 110 RT-PCR positive COVID-19 cases at GMCH, Khulna, Bangladesh from 1 July, 2021 to 31 August, 2021. Demographic, clinical, laboratory and radiological data of the patients were recorded and analyzed. Results: Among 110 study subjects, 51.8% were male. The mean age was 52.6 years, with majority (43.6%) belonging to the age group of 40-59 years. Upon admission, the most frequent symptoms were fever (94.5%), cough (86.4%) and dyspnea (79.1%). Diabetes mellitus (42.7%) and hypertension (33.6%) were the most common comorbidities. Regarding laboratory parameters, neutrophilia and lymphocytopenia were observed in 72.7% and 58.2% cases, respectively. The mean D-dimer (2.9 mg/l) and CRP (61.7 mg/l) levels were above their normal limits. In high resolution CT scan of the chest (HRCT chest), bilateral lung involvement was present in 85.5% cases. Ground-glass appearance was the most frequent (89.1%) radiologic pattern. Among the study subjects, empirical antibiotic, antiviral (remdesivir) drug, and systemic glucocorticoid were given to 97.3%, 83.6% and 56.4% patients, respectively. Total 15 (13.6%) patients were severely affected with COVID-19 and admitted to the ICU, requiring mechanical ventilation. During our study, 12 patients (10.9%) died either due to multiple organ dysfunction syndrome or cardio-respiratory failure. Conclusion: The study provides key information about clinical characteristics and general management of COVID-19 patients, which may help physicians to identify the factors associated with adverse outcomes in this disease. Mediscope 2022;9(1): 9-15

Epidemiological analysis of SARS-COV-2 B.1.617.2 (delta variant) transmission in an educational institute

BackgroundDespite having an effective COVID-19 vaccine, the COVID-19 pandemic is far from over and the delta variant continues to cause havoc across several continents. The present study was conducted to analyze and describe the occurrence of COVID-19 cases among completely vaccinated individuals. MethodsIn an educational institute in Western Maharashtra, we analyzed a cluster of RTPCR positive COVID-19 cases among fully vaccinated students which occurred in 12 days. The cases were linked to a series of curricular and co-curricular events in the institute. A detailed epidemiological investigation and genome sequencing of cases were conducted. IgG antibodies against S1 protein of novel SARS-CoV-2 were estimated for cases and age, sex, and vaccination status matched controls. ResultsAll 37 identified cases were mild COVID. 188 high risk (HR) contacts of the cases were identified. The overall secondary attack was 9.5%. Out of 31 cases and 50 controls, 09 (29%) cases and 08 (16%) controls were found to have IgG antibodies against S1 protein of novel SARS-CoV-2 titer of more than 60 U/ml. Whole-genome sequencing of 15 samples of the cluster showed the presence of the Delta variant of SARS-CoV-2. No correlation was observed between Ct value and IgG S1 antibody titers. ConclusionThe study provides significant evidence that only vaccination alone does not completely protect against SARS-CoV-2 B.1.617.2 (Delta) variant infection. An all-encompassing multicomponent strategy involving implementation of NPIs, robust contact tracing, early identification and isolation of cases, and high vaccination coverage is the way forward for the prevention of COVID-19.

COVID-19 prognostic modeling using CT radiomic features and machine learning algorithms: Analysis of a multi-institutional dataset of 14,339 patients

BackgroundWe aimed to analyze the prognostic power of CT-based radiomics models using data of 14,339 COVID-19 patients. MethodsWhole lung segmentations were performed automatically using a deep learning-based model to extract 107 intensity and texture radiomics features. We used four feature selection algorithms and seven classifiers. We evaluated the models using ten different splitting and cross-validation strategies, including non-harmonized and ComBat-harmonized datasets. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were reported. ResultsIn the test dataset (4,301) consisting of CT and/or RT-PCR positive cases, AUC, sensitivity, and specificity of 0.83 ± 0.01 (CI95%: 0.81–0.85), 0.81, and 0.72, respectively, were obtained by ANOVA feature selector + Random Forest (RF) classifier. Similar results were achieved in RT-PCR-only positive test sets (3,644). In ComBat harmonized dataset, Relief feature selector + RF classifier resulted in the highest performance of AUC, reaching 0.83 ± 0.01 (CI95%: 0.81–0.85), with a sensitivity and specificity of 0.77 and 0.74, respectively. ComBat harmonization did not depict statistically significant improvement compared to a non-harmonized dataset. In leave-one-center-out, the combination of ANOVA feature selector and RF classifier resulted in the highest performance. ConclusionLung CT radiomics features can be used for robust prognostic modeling of COVID-19. The predictive power of the proposed CT radiomics model is more reliable when using a large multicentric heterogeneous dataset, and may be used prospectively in clinical setting to manage COVID-19 patients.

Evaluation and Validation of the Roche Elecsys SARS-CoV-2 Antigen Electro-Chemiluminescent Immunoassay in a Southeast Asian Region.

Introduction: SARS-CoV-2 antigen tests can complement and substitute for RT-PCR tests. Centralized laboratory automated SARS-CoV-2 antigen tests that can be scaled to process a large number COVID-19 cases simultaneously are now available. We have evaluated the new Roche Elecsys SARS-CoV-2 antigen electro-chemiluminescent immunoassay. Methods: The Roche SARS-CoV-2 antigen assay is a double-antibody sandwich electro-chemiluminescent immunoassay, which reports a cut-off index (COI) (COI ≥ 1.0 considered positive). We assessed assay precision and linearity, and confirmed the reactivity limit. We determined the assay sensitivity and specificity with a verification group (289 controls and 61 RT-PCR positive COVID-19 cases). Assay performance was also validated against the consecutive samples we received (7657 controls and 17 cases) for SARS-CoV-2 antigen testing from June to October 2021. Result: The assay had a within-run precision CV of 3.0% at COI 0.68, and a CV of 1.5% at COI 3.49. Between-run precision was 3.0% at COI 0.68 and 1.8% at COI 3.49. The assay was linear from COI 0.65 to 7.84. All 35 C50 ± 20% test results performed over 7 days were positive/negative, respectively. In the verification group, overall sensitivity was 42.6% (26/61 positive, 95% CI 30.0–55.9), and specificity was 99.7% (1/289 positive, 95% CI 98.1–100). The agreement between the SARS-CoV-2 antigen and the RT-PCR cycle threshold (Ct) count was good (r = 0.90). In cases with Ct counts ≤ 30, the antigen assay sensitivity improved to 94.7% (18/19 positive, 95% CI 74.0–99.9). In our validation group, antigen sensitivity was 62.5% (5/8 antigen positive, 95% CI 24.5–91.5) within the first week of disease onset, but no cases were reactive after the first week of disease onset. Conclusion: The Elecsys SARS-CoV-2 antigen assay has good performance within manufacturer specifications. The sensitivity of the Roche antigen assay was greatest when used in patients with lower RT-PCR Ct values (≤30) and within the first week of disease onset.